Health beliefs, illness perceptions and determinants of breast screening uptake in Malta: a cross-sectional survey

Abstract

BackgroundWomen’s beliefs and representations of breast cancer (BC) and breast screening (BS) are salient predictors for BS practices. This study utilized the health belief model (HBM) and common-sense model (CSM) of illness self-regulation to explore factors associated with BS uptake in Malta and subsequently, to identify the most important predictors to first screening uptake.MethodsThis cross-sectional survey enrolled Maltese women (n = 404) ages 50 to 60 at the time of their first screening invitation, invited to the National Breast Screening Programme by stratified random sampling, with no personal history of BC. Participants responded to a 121-item questionnaire by telephone between June–September 2015. Data were analyzed using descriptive statistics, chi-square tests and logistic regression.ResultsThere is high awareness of BC signs and symptoms among Maltese women (>80% agreement for 7 out of 8 signs), but wide variation about causation (e.g., germ or virus: 38.6% ‘agree’, 30.7% ‘disagree’). ‘Fear’ was the key reason for non-attendance to first invitation (41%, n = 66) and was statistically significant across all subscale items (p < 0.05). Most items within HBM constructs (perceived barriers; cues to action; self-efficacy) were significantly associated with first invitation to the National Breast Screening Programme, such as fear of result (χ2 = 12.0, p = 0.017) and life problems were considered greater than getting mammography (χ2 = 38.8, p = 0.000). Items within CSM constructs of Illness Representation (BC causes; cyclical cancer timeline; consequences) were also significantly associated, such as BC was considered to be life-changing (χ2 = 18.0, p = 0.000) with serious financial consequences (χ2 = 13.3, p = 0.004). There were no significant associations for socio-demographic or health status variables with uptake, except for family income (χ2 = 9.7, p = 0.047). Logistic regression analyses showed that HBM constructs, in particular perceived barriers, were the strongest predictors of non-attendance to first invitation throughout the analyses (p < 0.05). However, the inclusion of illness representation dimensions improved the model accuracy to predict non-attendance when compared to HBM alone (65% vs 38.8%).ConclusionsInterventions should be based on theory including HBM and CSM constructs, and should target first BS uptake and specific barriers to reduce disparities and increase BS uptake in Malta.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4324-6) contains supplementary material, which is available to authorized users.

Knowledge, Attitudes and Breast Cancer Screening Practices among Market Women in Thika Town, Kiambu County, Kenya

“…A higher proportion of respondents (70.5%) in this study correctly identified the symptoms of breast cancer presented to them while fewer (50%) correctly identified risk factors for the cancer depicting partial knowledge of breast cancer among the respondents. These findings are consistent to those of Morse et.al (20) in Tanzania and Marmara et.al (21) in Malta who found variations in both knowledge of symptoms and breast cancer risk factors. The sources of information mentioned in this study included the electronic media (radio and television) and hospitals similar to findings of a review by Ojewusi et.al, (22).…”

“…All the respondents in this study were afraid of being diagnosed with breast cancer. These findings were comparable to those of a Maltese screening program which was organized and found that majority of non-attendees were afraid of the result of the screening programme (21). A large portion of the respondents were afraid of being disfigured.…”

Age-dependent impact of breast cancer risk perception on mammography screening behavior in Brazilian women

“…Labrie and colleagues [24] suggested that fear of breast cancer increased the perception of personal risk among women aged 30 -49 years. A recent study performed in Malta suggested that non-adherence to organized MS programs was associated with fear [25]. Similarly, women in our present study who feared the disease might have tended to overestimate numeric risk, estimate comparative risk mainly accurate and fear could also lead to avoidance of MS.…”

Lifetime utilization of mammography among Maltese women: a cross-sectional survey

“…Although general barriers to screening by mammography in Malta have been identified in our earlier study [ 19 ], our findings showed that our screening cohort consisted of attendees and non-attendees to the Maltese Breast Screening programme (MBSP); however, we recognised that the MBSP non-attendees consisted of a heterogeneous group of women with diverse reasons for non-attendance. Hence, screening non-attendees were not a single group of non-compliant Maltese women, but consisted clearly of two distinct subgroups: Women, who had obtained a mammogram outside the MBSP, possibly as a self-initiated action or routine check-up [ 15 ] or as part of private breast awareness campaigns, which may have been based on their recognition of susceptibility to BC and high self-efficacy in preventing BC [ 20 ], and ‘Real’ non-attendees i.e.…”